Nutritional Status as a Predictive Biomarker for Immunotherapy Outcomes in Advanced Head and Neck Cancer

Abstract

The association between pretreatment nutritional status and immunotherapy response in patients with advanced head and neck cancer is unclear. We retrospectively analyzed a cohort of 99 patients who underwent treatment with anti-PD-1 or anti-CTLA-4 antibodies (or both) for stage IV HNSCC between 2014 and 2020 at the Johns Hopkins Hospital. Patient demographics and clinical characteristics were retrieved from electronic medical records. Baseline prognostic nutritional index (PNI) scores and pretreatment body mass index (BMI) trends were calculated. Associations between PNI and BMI were correlated with overall survival (OS), progression-free survival (PFS), and immunotherapy response. In univariate analysis, there was a significant correlation between OS and PFS with baseline PNI (OS: HR: 0.464; 95% CI: 0.265–0.814; PFS: p = 0.007 and HR: 0.525; 95% CI: 0.341–0.808; p = 0.003). Poor OS was also associated with a greater decrease in pretreatment BMI trend (HR: 0.42; 95% CI: 0.229–0.77; p = 0.005). In multivariate analysis, baseline PNI but not BMI trend was significantly associated with OS and PFS (OS: log (HR) = −0.79, CI: −1.6, −0.03, p = 0.041; PFS: log (HR) = −0.78, CI: −1.4, −0.18, p = 0.011). In conclusion, poor pretreatment nutritional status is associated with negative post-immunotherapy outcomes.

The Geriatric Nutritional Risk Index (GNRI) as a Prognostic Biomarker for Immune Checkpoint Inhibitor Response in Recurrent and/or Metastatic Head and Neck Cancer

“…Moreover, albumin decrease has been shown to be associated with rapid clearance of pembrolizumab in advanced cancer [ 31 ]. Second, the GNRI incorporates ideal weight into its calculation, which better resembles dynamic changes in chronic diseases such as tumor cachexia [ 26 , 27 , 32 ]. For example, Johannet et al showed that malnutrition, defined as weight loss six months prior to treatment, had a negative impact on immunotherapy response in non-small cell lung cancer, while baseline BMI did not [ 26 ].…”

Predictive value of the preoperative prognostic nutritional index for postoperative progression in patients with pancreatic neuroendocrine neoplasms

“…Cadwell et al found that in elderly cancer patients, PNI was associated with 6-month postoperative mortality ( 33 ). In addition, the PNI can be combined with the neutrophil/lymphocyte ratio (NLR), and lactate dehydrogenase (LDH) to synergistically assess PFS and OS in patients with advanced cancer, receiving immunotherapy ( 34 , 35 ). It has also been reported that the PNI has a significant association with prognosis in patients undergoing surgery and who have digestive system tumors, such as liver and gastric cancer ( 36 , 37 ).…”

Optimizing the prescription doses and tolerability of systemic therapy in head and neck cancer patients

“…Early, late, and no nutritional counselling resulted in a 1-year OS rate of 95.0, 87.5, and 81.3% ( P = 0.035) in 243 locally advanced-HNSCC patients scheduled for chemoradiation [67]. Another retrospective study suggested a correlation between baseline prognostic nutritional index and OS and PFS (OS: HR: 0.464;95% CI: 0.26–50.814; P = 0.007 and PFS: HR: 0.525;95% CI: 0.341–0.808; P = 0.003 in HNSCC patients receiving immunotherapy [68]. An Italian study will evaluate the efficacy of immunotnutrition to improve tolerance to chemoradiation in locally advanced-HNSCC and is currently ongoing (NCT04611113) [69].…”